Major Defects Research Articles

Three-Dimensional Transperineal Ultrasound Guiding Early Secondary Repair of Obstetric Anal Sphincter Injury in an Incontinent Patient without Suture Dehiscence.

We present the case of a 36-year-old primigravida who gave birth to a 3200 g baby by vacuum-assisted (Kiwi OmniCup™) operative vaginal delivery with mediolateral episiotomy. A "y"-shaped perineal tear with a grade IIIC obstetric anal sphincter injury (OASI) was diagnosed and repaired. Two days after delivery, in the absence of suture dehiscence, she started experiencing complete anal incontinence. A decision was made in association with a proctologic surgeon for an early secondary repair. Before surgery, a Three-dimensional transperineal ultrasound (TPUS) was performed. The exam revealed a major defect of the external anal sphincter at the 11 o'clock position. This allowed for the reopening of only a circumscribed area of the perineal suture and repair of the sphincters using the end-to-end technique. The symptoms regressed completely, and follow-up TPUS demonstrated the gradual wound healing process. Anal incontinence, secondary to obstetric anal sphincter injury (OASI), has a severe negative impact on women's quality of life. TPUS is an effective method to detect sphincter defects and monitor the healing process. This report investigates the feasibility of identifying the sphincter tear in an incontinent puerperal patient without suture dehiscence in order to target early secondary repair while minimizing its extent. TPUS has proven a safe and effective tool to guide early secondary repair of symptomatic OASI complications while minimizing the invasiveness of the procedure. Multidisciplinary management is crucial to ensure the adequate standard of care.

Role of Surgery in the Outcome Difference of Gastroschisis between High-income and Lowmiddle- income Countries: A Review

Gastroschisis is a major congenital abdominal wall defect where the abdominal viscera comes out through a gap right to the umbilicus. The management of gastroschisis requires prompt and aggressive medical and surgical intervention immediately after birth. However, there is a notable disparity in mortality rates between developed countries and LMICs. Despite various surgical technique adjustments, LMICs still suffer from a high mortality rate, with certain centers reporting a 100% mortality rate. This article seeks to examine the literature and evaluate the impact of surgical techniques on the outcome of gastroschisis.
 DS (Child) H J 2022; 38(2): 103-106

Role of non-chromosomal birth defects on the risk of developing childhood Hodgkin lymphoma: A Children's Oncology Group study.

Non-chromosomal birth defects are an important risk factor for several childhood cancers. However, these associations are less clear for Hodgkin lymphoma (HL). Therefore, we sought to more fully elucidate the association between non-chromosomal birth defects and HL risk. Information on cases (n=517) diagnosed with HL (ages of 0-14) at Children's Oncology Group Institutions for the period of 1989-2003 was obtained. Control children without a history of cancer (n=784) were identified using random digit dialing and individually matched to cases on sex, race/ethnicity, age, and geographic location. Parents completed comprehensive interviews and answered questions including whether their child had been born with a non-chromosomal birth defect. To test the association between birth defects and HL risk, conditional logistic regression was applied to generate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Children born with any non-chromosomal birth defect were not more likely to be diagnosed with HL at 0-14 years of age (aOR: 0.91; 95% CI: 0.69-1.21). No associations were detected between major or minor birth defects and HL (aOR: 1.34; 95% CI: 0.67-2.67 and aOR: 0.88; 95% CI: 0.57-1.34, respectively). Similarly, no association was observed for children born with any birth defect and EBV-positive HL (aOR: 0.57; 95% CI: 0.25-1.26). Previous assessments of HL in children with non-chromosomal birth defects have been limited. Using data from the largest case-control study of HL in those<15 years of age, we did not observe strong associations between being born with a birth defect and HL risk.

Antifungal medication use during pregnancy and the risk of selected major birth defects in the National Birth Defects Prevention Study, 1997-2011.

Recent studies suggest increased birth defect risk associated with maternal use of specific oral antifungals. We estimated associations between first-trimester antifungal use and selected non-cardiac birth defects using National Birth Defects Prevention Study (NBDPS) data. Participants with a pregnancy affected by a study-eligible birth defect ("cases") were ascertained from 10 birth defect surveillance programs; participants who delivered livebirths without a major birth defect ("controls") were randomly selected from birth records or hospital discharge lists. First-trimester antifungal use was self-reported via maternal interview. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for birth defects with ≥5 exposed cases using logistic regression. We estimated crude ORs and exact 95% CIs for birth defects with 3-4 exposed cases. Additionally, we conducted a probabilistic bias analysis of exposure misclassification. Our analysis included 19 624 cases and 11 427 controls; 257 (1.3%) cases and 123 (1.1%) controls reported first-trimester antifungal use. Of those who reported antifungals, 62.6% of cases and 64.2% of controls reported topical antifungals; 10.1% of cases and 4.9% of controls reported oral antifungals. We observed the strongest associations for encephalocele and Dandy-Walker malformation and modestly elevated estimates for several other defects. Bias-adjusted estimates were similar to the main analysis. First-trimester antifungal use was positively associated with several birth defects in our analysis, although CIs were imprecise. Further study is warranted to investigate associations between antifungal use and birth defects, including potential bias due to confounding by indication.

Incidence, distribution, disease spectrum, and genetic deficits of congenital heart defects in China: implementation of prenatal ultrasound screening identified 18,171 affected fetuses from 2,452,249 pregnancies

BackgroundCongenital heart defects (CHDs) are the most common birth defects. Assessment of the incidence, distribution, disease spectrum, and genetic deficits of fetal CHDs in China is urgently needed.MethodsA national echocardiography screening program for fetal CHDs was implemented in 92 prenatal screening–diagnostic centers in China.FindingsA total of 18,171 fetal CHD cases were identified from 2,452,249 pregnancies, resulting in 7·4/1,000 as the national incidence rate of fetal CHD. The incidences of fetal CHD in the six geographical regions, the southern, central, eastern, southwestern, northern, and northwestern, were 7·647 (CI: 7·383–7·915), 7·839 (CI: 7·680–8·000), 7·647 (CI: 7·383–7·915), 7·562 (CI: 7·225–7·907), 5·618 (CI: 5·337–5·906), and 4·716 (CI: 4·341–5·108), respectively, per 1,000 pregnancies. Overall, ventricular septal defect was the most common fetal CHD, accounting for 17.04% of screened pregnancies nationwide, and tetralogy of Fallot, the most common anomaly in the major defect of fetal CHD, was the second most common, accounting for 9.72%. A total of 76.24% cases of fetal CHD were found to be an isolated intracardiac single defect. The remaining 23.76% of cases of fetal CHD had multiple heart defects. Among all extracardiac malformations, the central nervous system (CNS) was the most common tissue with extracardiac anomalies associated with CHD, accounting for 22.89% of fetal CHD cases. Chromosomal karyotyping identified trisomy 18 as the most common chromosomal abnormality in fetal CHD. We also documented that CHD-containing syndromes could be identified with a comprehensive approach integrating prenatal ultrasound, MRI, pathological autopsy, and cytogenetics and molecular genetics.ConclusionImplementation of prenatal echocardiography as a practically feasible platform to screen fetal CHD will reduce the financial and emotional burden of CHD, which may facilitate intrauterine and neonatal intervention of CHD.

Assessing the Relationship Between Traditional In Vitro Fertilization and Birth Defects: A Systematic Review and Meta-Analysis

Background Previously published meta-analyses revealed that IVF combined with intracytoplasmic sperm injection (ICSI) had an increased risk of birth defects in children. ICSI is more invasive, expensive, and time-consuming than IVF, but both result in comparable live birth rates. Currently, despite traditional IVF being used less frequently nationally and internationally than combined IVF/ICSI, it is important to understand the relationship between traditional IVF and birth defects due to a paucity of literature. Objective This systematic review and meta-analysis focused on whether traditional IVF techniques increase the risk for “all” birth defects and “major” birth defects in singletons compared to naturally conceived children. Search Strategy PubMed and EMBASE databases adhered to PRISMA guidelines. Selection Criteria Study selection consisted of original publications in English reporting birth defects for IVF singletons vs. naturally conceived children. Data Collection and Analysis Nine selected items from STROBE criteria were employed to rate study quality. Random effect models were used to calculate pooled odds ratios. Results From 916 publications, fifteen studies met eligibility criteria. Eight studies were rated as high quality, while the remaining 7 were rated as medium. A higher rate of “all” birth defects (pooled OR= 1.44 (95% CI:1.15-1.80) as well as a higher risk for “major” birth defects (pooled OR= 1.64; 95% CI: 1.24-2.18) were observed among traditional IVF-conceived singletons compared to naturally conceived children. Conclusions This is the first systematic review and meta-analysis to date to provide the highest available evidence that IVF is associated with “all” and “major” birth defects among IVF singletons compared to naturally conceived infants. Future large prospective studies should employ standardized reporting and uniform protocols for identifying birth defects with consistent diagnostic criteria for both minor and major birth defects, and comparable durations of follow-up in order to obtain an accurate estimate of birth defects after IVF.

Importance of a detailed anomaly scan after a cfDNA test indicating fetal trisomy 21, 18 or 13

ObjectiveTo investigate the effect of the presence or absence of fetal anomalies and soft markers diagnosed by ultrasound on positive predictive value (PPV) 21, 18 and 13 in pregnancies with a high-risk cfDNA result.MethodsRetrospective study including singleton pregnancies with high-risk NIPT results for common trisomies followed by invasive testing. The cases were grouped by gestational age at the time of invasive testing and by the presence or absence of fetal abnormalities or soft markers. The ultrasound was considered abnormal if at least one major defect or a soft marker was detected.ResultsA total of 173 women were included. Median maternal and gestational age was 37.7 years and 14.0 weeks, respectively. CfDNA test result showed high-risk for trisomy 21 and trisomy 18 or 13 in 119 and 54 cases, respectively. The “pre-ultrasound” PPV for trisomy 21 and for trisomy 18 or 13 were 98.3% and 68.4%, respectively. In case of a high-risk result for trisomy 21 and no fetal anomalies, the PPV was 86.7% while it was 100% if there were anomalies or markers present. In the case of a high-risk result for trisomy 18 or 13, the PPV was 9.5% if the ultrasound examination was normal and 100% if the ultrasound examination was abnormal.ConclusionThis study suggests that a detailed ultrasound examination performed after a cfDNA result that is high-risk for one of the common autosomal trisomies adds significantly to establishing an individualized risk assessment. This is particularly true in cases with a high-risk result for trisomies 18 or 13.

Experimental investigation on fresh and hardened properties of high strength fibre reinforced concrete using GGBFS and micro silica

The use of High Strength Concrete (HSC) has increased now a days. The concrete is one of the most useful construction materials, but the major defects of concretes are brittle in nature, low workability and low tensile strength. Experimental study is carried out to assess fresh and hardened properties of high strength fibre reinforced concrete (HSFRC) of grade M70. In addition to normal materials, silica fume and GGBS are added to achieve higher strength and poly propylene fibres are added to improve its ductility. The content of silica fume and GGBS is 5% and 25% respectively by weight of cement. Water to cementitious material ratio is 0.31. Mixes with different percentages of poly propylene fibres such as 0.5%, 0.1%, and 1.5% by the weight of cementitious content are denoted as HSFRC 1, HSFRC 2, and HSFRC 3, respectively. To improve the workability characteristics of the low water-binder ratio HSC mix, the Poly Carboxylate Ethylene-based chemical admixtures are used. The fresh properties were investigated in terms of slump flow and mechanical performances of the HSFRC over HSC are evaluated in terms of compressive, flexural, split tensile strength.

ASSESSMENT OF OUTCOMES OF RECONSTRUCTION FOR MAJOR SCALP DEFECTS USING LOCAL FLAPS OF VASCULAR PEDICLE

Objectives: Assess treatment outcomes of major scalp defects using local flaps of vascular pedicle. Materials and methods: Cross-sectional descriptive study on 16 patients with major scalp defects who received surgery at Center of Craniofacial and Plastic Surgery, Military Central Hospital 108 from September 2016 to April 2021. Participants were received reconstruction surgery to cover their defects using local flaps of vascular pedicle. Results: 15/16 participants were reconstructed using temporal fasciocutaneous flap based on superficial temporal artery pedicle, 1/16 participant was used skin flap based on occipital artery pedicle. Short-term results showed that 14/16 reconstruction flaps had good vitality and covered 100% of the defects. For each participant, the average surgery duration lasted 140 minutes, and the average post-operative hospitalization duration was 12 days. Long-term results showed that 16/16 flaps had good vitality and 100% coverage. Conclusions: reconstruction of major scalp defects using local flaps of vascular pedicle brought good coverage, high vitality, and was safe for patients, especially the elderly with many underlying diseases.

CLINICAL FEATURES OF MAJOR SCALP DEFECTS AT MILITARY CENTRAL HOSPITAL 108

Objectives: describe the clinical features of major scalp defects requiring surgery. Materials and methods: The above cross-sectional descriptive study included 16 patients with major scalp defects who received surgery at Center of Craniofacial and Plastic Surgery, Military Central Hospital 108 from September 2016 to April 2021. Participants were taken medical history, received clinical examination, and measured their defect sizes to record research indices. Results: Participants had an average age of 61 years old, male/female ratio = 1/1; 81.25% of them had comorbid chronic systemic diseases. The most common cause of the defects was scalp cancer, which accounted for 75%. The defects had an average area of 84.4cm2 and mainly located in the occipital region which occurred in 87.5% of patients, alone or combined with other regions, 100% of patients had to been removed the periosteum. Conclusions: Major scalp defects were mainly seen in elderly people with an average age of 61 years old, the ratio of male to female was equal. Chronic diseases accounted for 81.25%, the main cause was scalp cancer and accounted for 75%, common clinical symptoms were vegetations, ulcers, periosteal loss and defects mainly occurred in compression regions.

Homer 1 genotype AA variant relates to congenital splay leg syndrome in piglets by repressing Pax7 in myogenic progenitors

IntroductionPorcine congenital splay leg syndrome (PCS) is a major birth defect in piglets, resulting in lameness and high mortality rates. The multifactorial pathogenesis of PSC is not well understood but includes a polygenic inheritance.MethodsHere, in addition to morphological investigations, we characterized the expression of myogenic genes and functional (proliferation and differentiation) properties of myogenic precursor/satellite cells (SATCs) in 1 day-old PCS piglets, non-affected littermates (LCs), and piglets from PCS-free healthy litters (HCs). In addition, PCS phenotypes were related to the SNP Homer1_rs325197091 within the Homer1 locus, which has been identified as a potential hereditary cause of PCS.Results and discussionSamples from musculus semitendinosus (ST) of PCS piglets had a higher proportion of type II fibers, reflecting myofiber immaturity. In addition, myofiber atrophy, a lower number of myonuclei per fiber (ST), and a higher apoptotic activity (in ST and longissimus dorsi muscle; LD) were found in the PCS group. A higher proportion of cycling committed myoblasts (Pax7+/Ki67+ cells) occurred in samples from PCS-affected piglets, and on the other hand, the mRNA expression of genes involved in differentiation (muscle differentiation 1; MyoD, myogenin; MyoG) was repressed compared with HCs. Cultured SATCs from PCS-affected animals showed a temporal shift in peak expression of Pax7, MyoD, and MyoG toward days 3 and 4 of their 7 days differentiation regime. In vitro experiments with isolated SATCs confirmed the lower differentiation potential and the delayed progression of the myogenic processes in cells from piglets with PCS phenotype. In addition, Pax7 and desmin were differently expressed in Homer1_rs325197091 genotype variants (GG, GA, and AA). Both genes showed the lowest expression in the homozygous AA-variant, which was most frequently found in PCS-affected animals. The homozygous AA-variant was also associated with lower expression of the truncated Homer1-subtype 205. Thus, we hypothesize that in PCS, the balance between Homer1 proteins and its signaling functions is changed in a way detrimental to the myogenic differentiation program. Our results demonstrated direct negative effects of the Homer1 AA genotype on Pax7 expression, but the exact mode of action still needs to be elucidated.

Numerical and Experimental Study on Carbon Segregation in Shaped Billet of Medium Carbon Steel with Combined Electromagnetic Stirring

Carbon segregation is the major and classical internal defect in the continuous casting process of carbon steel. Based on the combined electromagnetic stirring equipment for new billet in a steel plant, China, the influence of combined electromagnetic stirring (M-EMS + F-EMS) on the carbon segregation of 300 mm × 340 mm special-shaped billet was studied via numerical simulation and on-site industrialization tests. The Lorentz force and carbon solute distribution were simulated under different EMS parameters. The formation mechanism of the carbon segregation of medium carbon steel with different combined electromagnetic stirring processes was analyzed. The results show that: (1) with the combined action of “solute flushing” effect and gravity, the carbon concentration in the loose side of the medium carbon steel casting billet is gradually lower than the fixed side, while the carbon concentration on the fixed side gradually accumulates more; and (2) under the action of combined electromagnetic stirring, the segregation index of casting billet could be controlled to remain between 0.96–1.05 and shows an increasing change in solidification from the skin to the center. When the current and frequency of M-EMS are 250 A and 2.0 Hz and the F-EMS are 180 A and 8.0 Hz, the carbon segregation defects in the special-shaped (300 mm × 340 mm) casting billet can be significantly improved.

Antiepileptic treatment with levetiracetam during the first trimester and pregnancy outcome: An observational study.

Levetiracetam is increasingly used in pregnant women with epilepsy. Although teratogenic effects have not been observed so far, data on the risks of spontaneous abortion and major birth defects are still limited, especially for the frequently used dual therapy of levetiracetam and lamotrigine. Our primary aim was to analyze rates of major birth defects and spontaneous abortion after maternal levetiracetam treatment. This was a cohort study based on pregnancies recorded by the Embryotox Center from 2000 to 2017. Outcomes of prospectively ascertained pregnancies with first trimester levetiracetam monotherapy (n = 221) were compared to pregnancies with lamotrigine monotherapy for epilepsy (n = 469). In addition, all pregnancies with levetiracetam (n = 364) exposure during the first trimester were analyzed in comparison to a nonexposed cohort (n = 729). Pregnancies with the most frequently used combination therapy comprising levetiracetam and lamotrigine (n = 80) were evaluated separately. There was no significantly increased risk of major birth defects or of spontaneous abortions after first trimester exposure to levetiracetam. Birth weight of male neonates was significantly lower after levetiracetam monotherapy compared to lamotrigine monotherapy. Dual therapy with levetiracetam and lamotrigine resulted in a significantly increased risk of spontaneous abortion (adjusted hazard ratio = 3.01, 95% confidence interval [CI] = 1.43-6.33) and a nonsignificant effect estimate for major birth defects (7.7%, n = 5/65, adjusted odds ratio = 1.47, 95% CI = .48-4.47) compared to a nonexposed cohort. Our study confirms the use of levetiracetam as a suitable antiepileptic drug in pregnancy. The lower birth weight of male neonates after maternal levetiracetam monotherapy and the unexpectedly high risk of spontaneous abortion and birth defects after dual therapy with levetiracetam and lamotrigine require further investigation.

Effect of nitrogen flow ratio on the structure and optical properties of AlN film

Aluminum nitride (AlN) films with different optical properties were prepared by radio frequency (RF) reactive magnetron sputtering technique under different nitrogen (N2) flow ratios. The films' microstructure and optical properties were investigated by XRD, XPS, SEM, UV-VIS and PL. The results showed that all the prepared films had hexagonal wurtzite structure and the sample prepared at 35 % N2 flow ratio obtained higher crystal quality and larger grain size (39 nm). The selective orientation of the films changed from (100) to (002) with the N2 flow ratio, accompanied with a surface morphology changed from worm-like to mixed structure, and eventually to a very regular pebble shape with a compact arrangement. The average transmission of the films exceeded 83 % in the wavelength range of 300–800 nm. The major internal defect affecting the band gap of AlN films was nitrogen-vacancy (VN), and the growth orientation and internal defects of AlN films were controlled by the N2 flow ratio to achieve the regulation of the energy band gap in a small range (5.47–5.68 eV). This can meet the requirement of solar-blind ultraviolet (<280 nm) photoelectric detection.

Visual Inspection Of Structures - Primary Aspect Of Structural Health Assessment

This article focuses on importance of visual inspection to observe conditions that can lead to structural and non-structural failures in civil construction. The subject article is based on structural failure reports information, condition assessment in generalized manner and practices which are being accepted in normal practices. Visual inspection procedures may help to identify the structural deficiencies in particular structural elements prior to becoming critical to challenge overall stability of integrated structure. Only generalized dangers can be revealed in visual inspections of the deterioration of structures. Experienced structural engineer is required for complete analysis of major structural defects.&#x0D;

Towards Laser Metal Deposition of Modified PH 13-8Mo Powder

Modified PH 13-8Mo alloy exhibits a good combination of corrosion resistance and mechanical properties for demanding applications in aerospace, petrochemical, and tooling industries. Additive manufacturing, specifically the laser metal deposition process with powder as feedstock (LMDp), has the potential to be utilized in these industries. However, very limited knowledge on the LMDp of this alloy currently exists. The aim of this work was, therefore, to deposit a multi-track single layer of modified PH 13-8Mo alloy as a first step towards 3D geometries, and to analyze the resulting microstructure by using Optical Microscopy, Scanning Electron Microscopy, X-Ray Diffraction, Electron Backscatter Diffraction, and micro-hardness. It was found that the multi-track single layer was free from major defects. The microstructure was heterogeneous, and it consisted of a martensitic matrix and small amounts of δ ferrite, austenite, and AlN. The results of this research will be used to tailor the microstructure and properties of future 3D additively manufactured components.

The Influence of the Deposition Speed during Friction Screw Extrusion Additive Manufacturing of AA6060

Solid-state additive manufacturing may solve critical issues typically arising during fusion-based additive manufacturing of high-strength aluminium alloys. In this work, the recently introduced Friction Screw Extrusion Additive Manufacturing (FSEAM) process was employed to manufacture wall-like rectangular builds of AA6060 T6 deposited with deposition speeds from 300 mm/min to 500 mm/min. All builds were manufactured at a tool rotation rate of 400 rpm with 1 mm layer thickness. The volumetric supply rates were adjusted to maintain constant build width. Solid builds were formed without major defects over the full range of deposition speeds. The process generated sufficient normal force and heat at all deposition speeds which resulted in manufacturing of defect free builds. The resulting average grain size was consistently below 5 micrometer throughout all builds independent of deposition speed or location through the height. Microhardness measurements revealed a decrease in hardness from a feedstock value of 80 HV to around 50 HV in all manufactured builds. Tensile tests in the building direction showed consistent results for all the samples as a result of defect-free parts, demonstrating a tensile strength of approximately 150 MPa, yield strength of 100 MPa, and uniform elongation of 12-15%. The fracture surfaces revealed large amounts of dimples at all deposition speeds in line with the high degree of plastic deformation preceding fracture observed from the tensile tests. The obtained results indicated that FSEAM is a promising process for solid-state additive manufacturing of aluminium alloys.

The origin of the n-type conductivity for Ta-doped SnO2: Density functional theory study

The electronic structure, intrinsic defects and extrinsic doping of SnO2 are studied by using the hybrid functional method. Research shows that SnO2 is a direct gap semiconductor. Along the Γ-M (Γ-Z) direction, the electron effective mass is 0.23 (0.19) m0 (m0: the mass of the free electron). When the Hartree-Fock mixing parameter (α) increases to 38%, the calculated band gap for SnO2 is 3.53 eV, which is close to the experimental results. For nonstoichiometric SnO2, both VO and Snint are major n-type defects, and the ionization energies ε(0/+) are above the conduction band minimum (CBM). About Ta-doped SnO2, obtained results show Ta substituting Sn (TaSn) is a predominate n-type defect. This work could promote the understanding of the n-type conductivity of SnO2 and provide significant guidance for their applications in transparent electronics.

The Central Facial Defect Reconstruction Using a Radial Forearm Free Flap after Malignant Cutaneous Tumor Ablation.

Acquired defects of the central face pose significant challenges in achieving acceptable cosmetic and functional outcomes. The site, size, and depth of tissue loss often render local tissues inadequate for the repair of major nasal defects. In this article, we aim to demonstrate the efficacy of radial forearm-free flaps as an ideal choice for various central facial unit reconstructions. This study encompassed patients treated between 2020 and 2022 who underwent facial reconstruction using radial forearm flaps. These flaps were employed in eleven patients with defects involving the lower lid, nose, upper lip, and lower lip. Additionally, we used osteocutaneous flaps in one patient to reconstruct a right nasal bone defect. In three patients requiring medial and lateral canthal tendon reconstruction in one case and oral sphincter reconstruction in two cases, the palmaris longus tendon was included with the flap. In the majority of cases, we achieved good to excellent aesthetic and functional results. Notably, there were no instances of flap failure or partial necrosis in this series. All patients experienced uneventful healing at the donor site. The radial forearm-free flap stands as an ideal and reliable method for reconstructing various facial defects. It offers efficient and thin-conforming skin coverage.

Implementation of Quality Control Tools in Woven Shirt Mass Customization for Enhancing Product Quality

Mass customization is a dynamic production approach catering to individualized orders. This study addresses the crucial concern of maintaining high-quality standards in woven shirt mass customization. This research delves into defect analysis and quality control, focusing on identifying, categorizing, and mitigating defects in the production process. By meticulously inspecting semi-finished and finished products, defects were recorded systematically on check sheets. Leveraging Pareto analysis, major and minor defects were prioritized, emphasizing critical issues that demand immediate attention. Additionally, a cause-effect diagram was employed to visually map the root causes behind these defects, paving the way for effective preventive measures. Findings highlight the challenges within woven shirt mass customization and underscore the significance of robust quality control. Notably, this research achieved reductions of 6.67% in the cutting section, 16.11% in the sewing section, and 11.11% in the finishing section defects. These outcomes translate into improved product quality and heightened customer satisfaction. This research provides insights for decision-makers and practitioners in the domain, encouraging the integration of comprehensive quality control methods into the production process. By focusing on defect analysis and causal factors, researchers anticipate a positive impact on the industry, resulting in enhanced product quality.